Provider Demographics
NPI:1669752804
Name:DOOMS, BONNIE RAE
Entity type:Individual
Prefix:MISS
First Name:BONNIE
Middle Name:RAE
Last Name:DOOMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 CENTRAL BLVD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2242
Mailing Address - Country:US
Mailing Address - Phone:925-642-2052
Mailing Address - Fax:
Practice Address - Street 1:1210 CENTRAL BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2242
Practice Address - Country:US
Practice Address - Phone:925-642-2052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist